Paper on sanitation determinants in rural Jharkhand, India

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Paper on sanitation determinants in rural Jharkhand, India

Dear colleagues,
I would like to share our latest paper on " Social determinants of environmental health: A case of sanitation in rural Jharkhand " Science of The Total Environment, 643, 762–774.

It should be freely accessible through THIS LINK for next 50 days.

• Cross-sectional analysis of household-level sanitation drivers in rural Jharkhand
• Identified low availability of toilets accompanied with their inconsistent use
• Low demand and perceived risks didn't explain variation in sanitation outcomes.
• Key importance of descriptive social norms but adverse effects of injunctive norms
• Structural barriers should be addressed together with social norms and attitudes.

An estimated 56% of households in rural India defecated in the open in 2015, making India the most significant contributor to the global sanitation burden. This cross-sectional study uses data collected in 2016 from 499 households in rural Jharkhand to understand the constraints of latrine adoption and drivers of sanitation preferences (plans to adopt toilets and willingness to pay for toilets). Focusing on a region with a large tribal population, the study examines two types of predictors, namely structural factors (objective socioeconomic, sociocultural and ecological characteristics) and psychosocial drivers (perceived unaffordability of toilet, hygiene and sanitation knowledge, perceived health risks, attitudes, both descriptive and injunctive social norms, and perceived water stress). We find that structural constraints related to educational, economic and sociocultural inequalities predict toilet ownership. Low sanitation rates can neither be attributed to a lack of expressed demand nor lack of recognition of the disadvantages of open defecation. Similarly, variations in sanitation preferences are neither explained by differences in hygiene and sanitation knowledge nor by understandings of sanitation health risks. We find that perceived unaffordability, attitudes (perceived benefits of toilet and disadvantages of OD) and perceived descriptive social norms are of key importance. This implies a potential for persuasive strategies that manipulate social norms around sanitation, particularly if they simultaneously address perceptions around financial unaffordability of toilets and around the benefits of toilets. Importantly, however, attempts to change sanitation preferences by acting on forces of social (dis)approval (i.e. through perceived injunctive social norms) may be ineffective and generate negative unintended consequences.

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